American journal of hospital medicine, volume 4, issue 3 (2020 July-September)
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Item Oral versus Intravenous Antimicrobials for Serious Infections(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-07) Rojas-Moreno, Christian"There is a common belief among physicians and patients, that “intravenous (IV) antibiotics are better than oral antibiotics, they are stronger, they work faster”. However, for many infectious conditions, including serious infections, there is no conclusive evidence that IV antibiotics are superior to oral antibiotics. The bacteria also do not know how the antibiotic gets to the infection site 1. Additionally, IV antibiotics are not a panacea without downsides. IV antibiotics are associated with prolonged hospital stays; they may be associated with more adverse events and higher costs. The line needed for outpatient parenteral antimicrobial therapy (OPAT) can complicate in 22% of cases, with almost half of them requiring emergency department visit or hospital admission 2."Item Endoscopic Ultrasound for the Treatment of Gastric Variceal Bleeding in a Patient with Portal Cavernoma(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2020-07) Boyd, Alexander; Mahon, Brinder S.; Rajoriya, Neil"A 30-year-old lady was admitted with two weeks of fever and right upper quadrant pain. She had a background of non-malignant, non-cirrhotic portal vein thrombosis (PVT) with cavernoma formation. There was no detected underlying pro-thrombotic condition. She had established portal hypertension with esophageal varices. Her portal cavernoma was complicated by portal biliopathy and concurrent gallstone disease - with an endoscopic retrograde cholangio-pancreatography (ERCP) and stenting four weeks prior to admission. Drug history included carvedilol for primary prophylaxis of bleeding, anticoagulation had not been undertaken due to collateralisation. Admission computerised tomography (CT) revealed multiple small liver abscesses with a patent biliary stent and no progression of PVT and she was treated conservatively with intravenous antibiotics."--Case summary and discussion